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Massachusetts Medical Society's
Physician Focus

August 2011

Parkinson's Disease

PROGRAM HIGHLIGHTS:

  • Parkinson’s disease is a chronic neurological disorder of the brain that affects a person’s muscle control and bodily movements.

  • The disorder causes tremors or shaking of the face, arms, or legs; stiffness in the limbs or trunk; slowness of movement; and poor balance and coordination.

  • The condition affects nearly one million people in the United States, with 50,000 to 60,000 new cases being diagnosed each year.

  • The disease is named after James Parkinson, an English doctor who in 1817 published the first detailed description of the condition in An Essay on the Shaking Palsy.

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 ADDITIONAL RESOURCES

American Parkinson Disease Association

The Michael J. Fox Foundation for Parkinson’s Research

Boston University Medical Center

National Institute of Neurological Disorders and Strokes

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Parkinson's Disease PSA

Standing, Bruce Karlin, M.D., Seated, Anna Hohler, M.D., Samuel A. Frank, M.D.
hi-res photo
promo slide

Theories exist, but the specific causes are unknown. Research is ongoing, with exciting developments, but there’s no cure at present or near at hand. The good news is that the available medications and therapies for Parkinson’s disease allow patients with this disorder to have a good quality of life.

“Parkinson’s disease includes a constellation of symptoms,” says Samuel Frank, M.D. “It usually consists of tremors, slowness of movement, walking problems, or balance issues. We differentiate that from Parkinsonism or Parkinson-like disease, which may be just slowness or stiffness, by the story that people tell us when they come into the office and by the physical exam we do. Right now there is no blood test or X-ray or MRI to diagnose the disease. It is done by history and physical examination.” 

Dr. Frank, Associate Professor of Neurology at Boston University School of Medicine, joined Anna Hohler, M.D., Assistant Professor of Neurology at the school, as guests on the August edition of Physician Focus. The two, both board-certified neurologists on the staff at Boston Medical Center who specialize in the treatment of patients with Parkinson’s disease, engaged in a detailed discussion of the condition along with program host and primary care physician Bruce Karlin, M.D. 

An accurate diagnosis can be difficult, the physicians said, because of the lack of known causes and the absence of testing to pinpoint the disorder. Physicians must look beyond the single feature of tremors, they emphasized, and examine how the condition may be affecting aspects of daily life.

“It’s important to look at the whole picture,” says Dr. Hohler, “including non-motor features. Some of these would include seeing if the patient has a “poker face” or decrease in animation of the face, slowness of speech, a history of constipation, problems with sleep, or issues surrounding mood.” All of those, she says, along with a history of risk factors and a physical examination, can help lead physicians to a proper diagnosis. 

While the disease is known to be intrinsic to the brain, where degeneration occurs in certain parts of the brain, the specific causes of the condition are unknown. Theories about causes include genetic predisposition and environmental exposure – especially to heavy metals or pesticides. Head trauma is also high on the list of suspected triggers. 

One known characteristic of the condition is a dramatic drop in the amount of dopamine in the brain. Dopamine, a neurochemical that sends signals between neurons, helps regulate movement, among other functions. Replacing the dopamine lost over time with medication is part of the treatment for patients with Parkinson’s disease. 

What might future treatment entail? 

“We’re looking for a medication that can slow the progression of the disease,” says Dr. Frank. “Right now we’re good at treating the symptoms, particularly those related to dopamine, but we can’t slow the progression. But people are living longer and living better with it.” 

“We approach every patient individually,” says Dr. Hohler. “We tailor their medication and treatment, including physical therapy.” And there’s the hope, even without a cure at this time. 

“People with Parkinson’s disease can have a very wonderful quality of life,” Dr. Hohler emphasized, “provided they stay in close contact with their physician, stay with proper medications and have those adjusted, and be involved in healthy living with exercise and diet.” 

Watch the accompanying video for the full discussion, including details about the steps neurologists take to make their diagnosis; how they evaluate the disorder’s many symptoms, which are common to other diseases; how they differentiate between Parkinson’s disease and Parkinson-like conditions; and how the disease is treated, including surgical options like deep brain stimulation.

Text:
MMS/Richard Gulla